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Purpose: To compare the incidence of distal emboli occurring during percutaneous transluminal angioplasty (PTA) and primary stent on the superficial femoral artery (SFA) Methods: A total of 50 consecutive patients were entered in a prospective, randomized trial. Inclusion criteria were the presence of symptomatic limb ischemia due to stenosis or occlusion of the SFA. An embolic protection device was placed in the popliteal artery. The patients were then randomly assigned to undergo primary stent implantation or PTA. The filters were retrieved and sent for histologic examination. Results: Stenting in the SFA produced more emboli (1.44 mm3) than PTA (0.772 mm3), P = .031. Reanalyzing the patients according to actual treatment performed, volume of debris in the stent group was 1.271 mm3 and in the PTA group was 0.191 mm3, P = .00087. Conclusion: Volume of embolized material during endovascular interventions in the SFA-above-knee popliteal artery is higher when a stent is used.

The aim was to present a technical modification to the ‘funnel technique’ that allows endovascular repair of infrarenal abdominal aortic aneurysms with an ectatic neck. The body of the Excluder endograft is opened inside the aneurysm, using the slow deployment technique, stopping as soon as the contralateral limb is open. The gate is cannulated in the usual fashion. A percutaneous transluminal angioplasty (PTA) balloon is introduced in the contralateral limb and inflated to nominal pressure. By pulling the introducer of the Excluder delivery system on one side and the PTA balloon on the other, the graft is positioned on the bifurcation with the contralateral leg inside the common iliac artery. At this point, the ipsilateral iliac leg is deployed and the thoracic endograft can be positioned through the abdominal component. Finally, the contralateral iliac leg is deployed. The technique described offers a simple method to treat aortic abdominal aneurysms with an ectatic neck by positioning a bifurcated abdominal graft in such a way that subsequent insertion of the thoracic component is facilitated.

Profunda femoris artery (PFA) aneurysms are rare and they are usually treated with open surgery. We report the case of an 87-year-old patient who during the preoperative work-up for an abdominal aortic aneurysm was found to have a 4.2-cm aneurysm of the right PFA. A percutaneous transcatheter coil embolization was successfully performed using a contralateral retrograde approach. To date, only three patients, including the present case, have been treated with transcatheter coil embolization for a PFA aneurysm. In the absence of concomitant superficial femoral artery disease, embolization of aneurysms of the profunda femoris seems to be a safe and minimally invasive alternative to open repair in selected patients.

A 69-year-old man with no previous history of peripheral arterial disease was admitted for evaluation of acute left leg ischemia. Physical examination revealed normal pulses on the right leg; on the left the femoral pulse was reduced; popliteal and pedal pulses were undetectable. Angiography showed a unilateral persistent sciatic artery on the left (Fig A. PSA, persistent sciatic artery; PFA, profunda femoris artery; SFA, superficial femoral artery), continuous with the popliteal artery, which was occluded at its origin (Fig B. PA, popliteal artery). The distal superficial femoral artery appeared hypoplastic and did not supply significant flow to the lower extremity. Thrombolytic therapy with selective intra-PSA urokinase infusion was followed by normalization of leg perfusion (C). Femoral left artery showed unchanged reduced pulsation with normal popliteal and pedal pulses (Cowie’s sign).